The Evaluation Of Effect And Benefit In Herpes Zoster Clinical Pathway In Traditional Chinese Medicine

BackgroundClinical pathway is a standardized approach of diagnosis and treatment system. It is a standardized treatment mode which could practice in the rules on continuous quality improvement (CQI) and conserve medical resources. It could improve the quality of medical serves. Researches on Clinical Pathway in Traditional Chinese Medicine are little at present. And researches on Clinical Pathway of dematologic diseases in Chinese Medicine are rare. Therefore, there are some questions which this research could focus on, such as:how to evaluate the effect and advantages of TCM treatments in clinical pathway, how to reflect that the TCM treatments are effective but low in cost.Herpes zoster is an acute dermatologic disease, involving both nerve and skin, caused by the varicella-zoster virus. It is the common disease in dermatology. The costs of hospitalization vary among different patients, while the basic treatments are mostly the same. Therefore, this research chose herpes zoster to evaluate the effect and benefit of Clinical pathway. The Asynchronous control study was used to compare the clinical efficacy and Economic benefits with the ones in clinical pathway. Thus it could offer pieces of advice and experiences for TCM clinical pathway in other dermatologic diseases.ObjectiveTo construct a clinical pathway in Chinese Medicine for herpes zoster patients in hospital. And to observe clinical efficacy and economic benefits of this clinical pathwa. That was to provide the basis for the further optimization of the clinical pathway.Methods The herpes zoster clinical pathway in TCM was conducted and optimized by the references and experiences in recent years both home and abroad.. In this research, the clinical efficacy and Economic benefits were observed and evaluated, compared with the retrospective study. In the practice of herpes zoster CP in TCM, the data, such as age, sex, medication, clinical efficacy, Length of hospitalisation, hospital costs, variances and treatments and Satisfaction Survey for patients, were collected from September 2009 to October 2010.55 cases were recorded in all. In retrospective study, the data which met the inclusion criteria were collected from hospital medical record between January 2006 and November 2008. The clinical efficacy and economic benefits were discussed by comparing the data in herpes zoster CP with the ones in retrospective study.Result1 The general situation of herpes zoster and other diseases, medical payment, ratio of Integrative Medicine treatments in CP group and retrospective group showed no differences.2 The Chinese symdrome differentiation in CP path was more focused in the line with "TCM disease diagnosis and efficacy standards " published by the State Administration of Traditional Chinese Medicine. Selection of injection in TCM was basically in the line with the Chinese symdrome. The type of acupuncture became more. The medication in western medicine followed the principle:"good in effect but low in cost"3 Length of hospitalization:there were significant difference between the path group and the retrospective group (P<0.05). It showed that the length of hospitalization rose year after year before practice of CP, and that it shortened to the standard length of stay in clinical pathway.4 Hospitalization costs:there were significant difference between the path group and the retrospective group (P<0.05). But the costs between CP and retrospective study in 2006 showed no significant difference. It showed that there was an upward trend from 2006 to 2008. The costs went down after practice of clinical pathway, but with no difference from hospitalization costs in 2006. Category Comparison showed that:In CP group, costs of western medicine, Chinese patent medicine and laboratory tests declined;costs of herbs and treatments, bed costs had little difference;costs of radiation test increased year by year.5 Clinical efficacy:Out of 54 cases in CP,47 cured,5 significantly improved, 2 moderately improved, and 0 without improvement. There were significant difference between the path group and the retrospective group (P<0.05). It showed that the clinical efficacy improved after practice of CP.6 Follow-up:the incidence of postherpetic neuralgia is 11.11%. It showed there is no influence on the incidence of postherpetic neuralgia after practice of CP.7 Evaluation of satisfaction survey for patients:According to the satisfaction survey, patients were more satisfied with the attitudes of doctor and the clinical effecacy. While the satisfaction level was lower in waiting for the examinations and hospital admission. This showed that the next step to improve the satisfaction was to optimize the procedure of admission and to improve the cooperation between departments.8 Variances and its significance:there were three hundrand and two variances in hospitalization of 55 patients.8.1 The number of variances caused by system factors was four. These variances could be reduced by the coordination between the administrative and clinical departments.8.2 The number of variances caused by doctors and nurses was thirty-eight. Thirty-six of them were caused by the habits of doctors in checking and medication. These may be due to the medical safety and medical environment According to the herpes zoster clinical pathway proposal in TCM published by Administration of Traditional Chinese Medicine, the abdominal B ultrasound, coagulation, infectious disease could be added as the routine examinations in the proposal of the herpes zoster CP.8.3 The number of variances caused by patients'desire was twenty-two. These could be decreased by improving the training of doctors and the communication between patients and doctros. The doctors should meet the reasonable requirements, and persuade patients to give up the unreasonable ones.8.4 The number of variances caused by disease factors was two hundrand and thirty-eight. This showed that the operation of the external treatments should be standarized and detailed in the proposal of herpes zoster CP. The common checking and medication for certain symptoms or diseases should be detailed in the variances guideline in herpes zoster CP.8.5 The maximum variances occurred in the first day in hospital. And most of them were due to the doctors'habits of doing laboratory checking and medication.8.6 In accordance with the variances management,56.95% of the variances could be prevented by special learning of diagnosis and treatment, improve CP's management and communication with other departments. It was necessary to increase the times of variances discussion to to detect and identify the solutions to the control variances.9 Correlation Analysis about the Medical payments, length of stay, and hospital costs9.1 Correlation Analysis about Medical payments and the length of hospital stayThe differences in length of hospital stay between patients with different medical payments were not statistically significant. Medical payments of herpes zoster inpatients had no effect on the length of hospitalization.9.2 Correlation Analysis about Medical payments and the hospital costsMedicial payments was one of the factors of the hospitalization costs. Hopsital costs of medical insurance patients and publicly funded health insurance patients were higher than that of patients at their own expenses. This may be related to the less economic pressure on the patients with medical insurance and publicly funded health insurance.ConelusionThe results show that:1 After the application of clinical pathway for hospitalized patients with acute herpes zoster, the average length of stay was shortened, and the hospitalization costs were reduced.2 The results showed that the clinical efficacy improved after the application of CP. It optimized kinds of TCM treatments for herpes zoster. It showed the advantages of Chinese Medicine-efficiency but simple and inexpensive.3 Application of clinical pathways can improve the patient satisfaction, and reveal the next step for the further improvement of clinical efficiency integration of hospital procedures and cooperation between departments.4 The initial research on variances suggested the next improvement for CP in TCM could be:the cooperation between relevant departments to shorten the time waiting for examinations;increasing some routine examinations in hospital to ensure medical safety;defining clearly the corresponding examination and medication of common diseases as hypertension, diabetes, hyperlipidemia; standarized the medication for neuralgia in herpes zoster;standarizing the operation of external treatments;treatments of special kind of herpes zoster, etc.